DDFORMS.ORG – DD Form 2871 – Request to Restrict Medical and Dental Information – Medical and dental information is extremely personal and sensitive, containing details about an individual’s health conditions, diagnoses, treatments, and medications. In certain cases, individuals may want to restrict the disclosure of such information to maintain their privacy and protect themselves from discrimination or stigmatization. This is where the DD Form 2871 – Request to Restrict Medical and Dental Information comes into play.
The DD Form 2871 is a form used by military personnel, veterans, and their dependents to request that their medical or dental information be kept confidential in certain circumstances. This form allows individuals to specify who can access their medical records and under what circumstances they can be released.
Download DD Form 2871 – Request to Restrict Medical and Dental Information
| Form Number | DD Form 2871 |
| Form Title | Request to Restrict Medical and Dental Information |
| Edition Date | 12/1/2003 |
| File Size | 38 KB |
What is a DD Form 2871?
DD Form 2871 is a request form used by military personnel to restrict the disclosure of their medical and dental information. The form allows service members to limit who has access to their personal health information, including doctors, hospitals, and other healthcare providers.
The form is typically used for a variety of reasons, such as protecting sensitive medical conditions or preventing unwanted disclosures of personal health information. It is important to note that the form does not prevent healthcare providers from accessing necessary medical records in order to provide treatment.
To complete the DD Form 2871, individuals must provide their name, social security number, and other identifying information. They must also specify which types of medical or dental records they wish to restrict and indicate the duration of the restriction. Once completed, the form should be submitted to the appropriate authority for approval.
Where Can I Find a DD Form 2871?
If you are a member of the US military or a family member, and you need to restrict your medical or dental information from being disclosed, you will need to fill out a DD Form 2871. This form is used to request that personal medical and dental information be kept confidential. It can be important for those who may have sensitive medical conditions they do not want others to know about.
So where can you find this form? The easiest way is to simply go online and search for “DD Form 2871” using your preferred search engine. You should be able to find a PDF version that you can download and print out. Another option is to visit the base legal office for your installation. They should have hard copies of all necessary forms, including DD Form 2871.
It’s important to note that while filling out the form is relatively simple, it must be done correctly in order for your request for confidentiality to be accepted. Be sure you read all instructions carefully before submitting it. Once completed, submit the form according to the instructions provided on the document or by contacting an authorized representative if unsure where or how it needs to be submitted.
DD Form 2871 – Request to Restrict Medical and Dental Information
The DD Form 2871 is a Request to Restrict Medical and Dental Information form that allows individuals to limit their medical and dental information from being disclosed to certain entities. This form is typically used by members of the military as well as their family members or dependents. The purpose of this form is to protect sensitive medical information from being accessed by unauthorized parties.
Individuals can request restrictions on their medical and dental information for various reasons, such as privacy concerns, fear of discrimination, or confidentiality requirements related to legal proceedings. The DD Form 2871 serves as a legally binding document that outlines the restrictions placed on an individual’s medical and dental information.
It’s important to note that while this form restricts the disclosure of medical and dental information, it doesn’t necessarily prevent healthcare providers from providing necessary care. In emergency situations, healthcare providers may still access an individual’s restricted information in order to provide appropriate treatment.
DD Form 2871 Example
